China and the WHO’s ‘Health Silk Road’ (健康丝绸之路)

In March 2020, when Dr Aylward, Senior Advisor to the WHO Director-General, cut short a video interview rather than comment on, or even mention, Taiwan’s impressive response to the Covid-19 crisis, it appeared that offending China was too great a risk to countenance. His lack of candour appeared a sinister indication of a greater failing on the part of the WHO.

During the first season of the Covid-19 emergency in early 2020, the WHO has been criticised for apparently ignoring warnings from Taiwan in December 2019, being too weak in pressing China for honest answers to vital epidemiology questions, too slow to declare a pandemic, and too quick to praise China’s handling of it. In late January 2020, after meeting with President Xi in Beijing, the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, praised China’s ‘transparency’.[1] In February 2020 at the Munich Security Conference, he said ‘China has bought the world time’.[2]

In fact, we don’t have to look far to see indications of the deepening structural relations between China and the WHO that may be creating these blind spots.

In January 2017, President Xi and the (then) Director-General of the WHO, Dr Margaret Chan, agreed for China and the WHO to implement jointly a ‘Health Silk Road’.[3] Upon being elected the new WHO Director-General in May 2017, Dr Tedros reiterated the organization’s adherence to the ‘one-China’ principle, thereby excluding any separate mention of Taiwan, in his first bilateral discussion with China’s Minister Li Bin. The WHO, not unnaturally, was looking towards further cooperation with China.[4] In August 2017, one month into his new post, Dr Tedros went to China to ‘mark an intensified strategic partnership between China and WHO’.[5] He ‘met privately with Premier Li Keqiang for a high-level discussion on a more strategic partnership between WHO and China, as well as how China can expand its international health security cooperation in Belt and Road countries’.[6] During this visit, China signed a MOU to give an additional voluntary contribution of US$20m to the WHO. Also, Beijing hosted a summit – ‘Towards a Health Silk Road’ – where Dr Tedros praised as “visionary” President Xi’s proposal for using China’s BRI for global health: “If we are to secure the health of the billions of people represented here, we must seize the opportunities the Belt and Road Initiative provides … Let us, the health leaders of 60 countries gathered here, and public health partners, build a healthy Silk Road, together.”[7]

China’s additional $20 million contribution to the WHO announced during that visit, however, should be seen in context. The WHO’s total annual budget is around $5.6 billion. Using WHO figures, Table 1 demonstrates how the ‘strategic partnership’ between China and the WHO is starkly out of proportion with regard to WHO funding. And even if President Trump follows through on US cuts to its WHO budget, the US is still likely to be the single largest contributor.[8] The relationship between China and the WHO is driven much more by the organisation’s desire to secure China’s active cooperation for the future of global public health in an age of ubiquitous globalisation. And that plays directly into Beijing’s sense of its own national interests.

Table 1. WHO Funding By Contributor in US$, Updated to Q4 2019, Showing Amount Invoiced To Member States For 2018-2019 Biennium

*Assessed contributions are the dues countries pay in order to be a WHO member. The amount each country must pay is calculated relative to its wealth and population.

SARS in 2003 cost China US$6.1 billion, or 0.5% of its GDP, and China’s bungled response to the outbreak was damaging to its international image.[9] It is not surprising that China would see benefits in engaging more proactively in global health to mitigate the human, fiscal and reputational damage of any future outbreaks. Yet despite its increasing engagement with global health, China’s approach remains fundamentally state-centric, contrary to the essence of global health diplomacy and governance.[10] The ‘Health Silk Road’ is fundamentally a feature of China’s signature foreign policy project, the Belt and Road Initiative. One tactic within a national strategy. It appears that the WHO lost sight of this reality or it has become too deeply enmeshed in China’s foreign policy to be able to unpick itself from difficult aspects.

Dr Tedros’ 5-year term as Director-General is due to expire in 2022. Even if a safe COVID-19 vaccine becomes available, and it is possible to administer it globally by then, the world will still be in the grips of the political, financial and societal fallout from the Wuhan outbreak. If the US acts on President Trump’s current rhetoric of cutting its WHO contribution, the organisation’s funding picture may be significantly altered. Indeed, US withdrawal, and the apparent fragmentation of the world market in medical supplies, could be China’s opportunity to expand greatly its soft power capacity in global health terms. But accepting a greater proportion of the WHO’s funding from China will come with implicit, and even explicit, political strings for an organisation that must be seen at all times to act as a world health organisation. As the ‘war of narratives’ plays out, on its current trajectory of praise for China the WHO’s reputation may be significantly reduced in the coming years – when its international credibility will be critical to the world’s ability to deal with future pandemics.

The essence of the problem is not the existence of the WHO itself. Like all UN bodies, it can only work with the membership it has. And in this case, its failings go back to its strategic pivot towards China that has been proactively seeking to engage (for its own national interest) with issues the WHO was established to tackle.

The WHO’s own review of its performance in this crisis will have to go further than succumbing to pressures from Beijing to airbrush Taiwan out of the picture as well as China’s inexcusable obfuscation. There is a deeper and more complex relationship that, for the good of the organisation and indeed for Beijing’s own ambitions to garner soft power advantages from its Belt and Road Initiative, should be straightened out more honestly and communicated to the world community as a net benefit to global public health.